Mortgage Application

Principal Applicant

Principal Applicant Current Address

How long have you been living at the current address?

Principal Applicant Previous Address

(Required if less then 3 years at current address)
How long have you been living at the previous address?

Principal Applicant Current Employment

1, 1.5, 2, 2.5 etc
1, 1.5, 2, 2.5, etc

Principal Applicant Previous Employment

1, 1.5, 2, 2.5 etc
1, 1.5, 2, 2.5, etc

Co-Applicant

Co-Applicant Current Address

How long have you been living at the current address?

Co-Applicant Previous Address

(Required if less then 3 years at current address)
How long have you been living at the previous address?

Co-Applicant Current Employment

1, 1.5, 2, 2.5 etc
1, 1.5, 2, 2.5, etc

Co-Applicant Previous Employment

1, 1.5, 2, 2.5 etc
1, 1.5, 2, 2.5, etc

Subject Property

Address Line 1

Other Properties (Owned)

Amount left in mortgage.

Other Income

Assets

Liabilities

Client Agreement and Consent

The undersigned applicant(s) (we or us, whether there is a single applicant of more than one) covenant and agree with (Name – broker)
licensed with mortgage alternatives. as follows:

a) that all information we provide to you in connection with any mortgage application or other service you provide (a transaction) will be
true and correct, and we acknowledge that you and any lenders or other persons to whom you submit that information will be relying
on it in order to consider our application and/or determine our creditworthiness;

b) that we hereby authorize you to obtain any further financial or other information you may require concerning us in connection with a
transaction from any sources to which you may apply and each such source is hereby authorized to provide you with such
information;

c) that we hereby authorize you to disclose to any lender, credit bureau, insurer, insurance agent or other person involved in a
transaction such personal and financial information concerning us as you consider appropriate and we consent to the retention by
those persons;

d) that we acknowledge and agree to your privacy policy, which we have been afforded an opportunity to review, and we hereby consent
to receiving email and other electronic communication from you;

e) that we hereby release you from all claims in damages or otherwise that we may have in connection with or arising from any use,
disclosure or release of any of our personal information, and that we will indemnify you against and save you harmless from any and
all claims in damages or otherwise which may be made by any third party in connection with or arising from any personal or other
information that we have provided to you;

f) that we will pay all legal, property appraisal, registration fee and other costs or expenses incurred by you in connection with a
transaction;

g) that you may retain our application and other personal information whether or not any transaction is ultimately completed;

h) that we acknowledge and agree that you may be entitled to receive financial compensation with respect to a transaction from a lender
or other person; and

i) that we may in our discretion make application for life, disability and/or critical illness insurance coverage in connection with a
transaction, and that we have no claim against you if we elect not to do so. I/we understand that the terms and conditions of qualifying
for coverage under such insurance are determined by the insurer, and that no such insurance will be in place unless and until I/we are
so notified by the insurer (see mortgage insurance quote for details).

j) That we give permission to you, your service providers, insurers, insurance agents/brokers and affiliates including but not limited to
Unitas Insurance Services Limited, to contact me on an ongoing basis to consider products or services that may be of interest to me.

I/we further acknowledge and agree that each potential mortgage lender, mortgage insurer or service provider to whom you provide the
mortgage application and/or my/our personal information, is permitted to receive such application and information and maintain records
relating to me/us, including my/our Social Insurance Number (SIN) if I/we provide it, and collect personal information from me/us, you and
from third persons, including credit bureau, credit reporting and collection agencies, financial institutions, my/our past and present
employers, creditors and tenants, my/our spouse or any other person who has information about me/us for the purpose of recording,
evaluating and responding to my/our application for mortgage financing or related activities and I /we specifically consent to the release
and disclosure of personal information by such persons to and among you and each potential mortgage lender, mortgage insurer or other
service provider.

Referral Source Fees

I/we acknowledge and I/we consent that there may be payment by you of a referral fee, where applicable, based on a fixed percentage of
the principal amount of my mortgage to the referral source including, but not limited to, real estate brokerage, builder, developer, financial
planning organization or insurance brokerage.

Co-Brokered

I/we acknowledge and I/we consent that our application may be co-brokered with another Mortgage Brokerage in order to secure a
Mortgage.

Principal Applicant Signature
Co-Applicant Signature